I’ve been beating the drum for public health care for a little while now–not as loudly as I should have, but definitely it’s been on my radar. After what my mom went through last year with not one, but two heart surgeries due to an "experimental" procedure-cum-clusterfuck, and all the horror stories my sister’s told me about being a freelancer while raising a son and trying to take care of one’s own health, the personal motives alone were enough for me to get involved.

But health insurance for myself isn’t easy to get. My company is profitable and pays me decently, but it’s tough to find a group insurer that will reliably cover a small business. Not enough profit in it unless you have a large number of employees. And private, self-insured plans like those offered by trade associations or professional groups are certainly worthy, but incredibly pricey and come with a list of things they don’t cover that’s as long as your arm.

Let me take a minute to explain my situation for those who don’t know me. I am what insurers and brokers would love to have as a customer–a guy who rarely sees the doctor, rarely gets sick, and is acutely interested in bettering his health. My biggest weakness is that I’m substantially overweight, but I certainly don’t need a doctor to tell me that. I’ve been working out like a demon and dieting strictly over the last six months, and though I still have a long way to go, I’ve lost 30 pounds and am healthier than I’ve been in years. Apart from that, I have low blood pressure, low cholesterol, no history of medical illness. (Hell, the last time I was in a hospital was in 2001 for an E.coli infection from drinking contaminated D.C. water.) I scrupulously consult medical information portals like WebMD for anything that might be a problem for me medically, and am generally that model of the "informed consumer" that the health insurance industry and its assorted sockpuppets like to trot out there as an alternative to real reform. But given that people can be turned down for coverage for the terrible crime of having allergies, I looked at myself as basically a recission waiting to happen.

Eventually, once I settled in to my new life here in L.A. I made a commitment to be healthier, and that included finding the right insurance plan for myself. But as luck or fate would have it, it was right in that black hole between insurance plans that I suddenly fell drastically ill.

This past week I got very sick all of a sudden.

Terrible abdominal pains, cramps, nausea, spasms, weakness, dizziness, you name it. After feverishly reading a dozen other medical reference sites, I was no closer to an answer. The problem with digestive/stomach maladies is that a lot of different diseases/infections/conditions have similar symptoms. You could be having really bad gas, an onset of Crohn’s disease, or acute appendictis, and be no closer to an answer. One set of symptoms would disappear, then another set would emerge.

I bought every over-the-counter and "alternative" medicine remedy I could find. Nothing worked–and in some cases, made things worse. I tried getting an appointment with a regular doctor or gastroenterologist, but two or three tries yielded the same thing–none of them were available for days at a time. I couldn’t even get a hold of one between 12 and 2 pm. No one was around. Sorry if my potentially fatal illness interrupted your golf game.

Finally, after about four days, the pain had gotten unmanageable, and was combined with shakes, dizziness, and heart tremors. I was so freaked out I went to the nearest hospital emergency room. The simple truth was that I feared for my life. I’m not afraid of death, but I’m not ready to die yet. I simply have too much yet to do.

Someone on Twitter said that a hospital emergency room is a lot like the DMV, only with patients. It’s so true. You sit for hours on end with people from all walks of life, all desperately wanting to be somewhere else–but in the case of the emergency room, many people are suffering and in great discomfort. Yet still they wait, and wait, and wait. You can’t really blame the staff for making them wait, however–9 times out of 10, they’re simply overworked, overburdened, and don’t have nearly enough staff or resources to process everyone.

I was a low priority patient, since I had no chest pains, broken limbs, or immediate risk. Despite the fact that it felt like there was a spiked bat in my stomach grinding up my insides, I sat patiently, talked to other patients, helped the nurses, read, and did whatever I could to stay calm. People were there with broken limbs, chest pains, dog bites, lacerations, and things you can’t believe they were able to survive, let alone admit themselves under their own power.

Finally, after four hours, I was let in, given the mandatory gown, peed in a cup, and set in a comfortable room with an IV sticking out of my arm. Periodically very nice nurses would come in to check on me and give me some foul liquid to drink, but mostly I waited, occupying myself with a book I brought along to read and watching TV ("Leverage" and "Kings" for the win!). And waited. And waited.

In that waiting, I don’t think I ever felt more elemental terror than I did at that moment. And the worst part? The terror wasn’t even over whatever was ailing me, it was how I was going to pay for all this. Every moment that ticked by I could feel the proverbial "meter" of expense running.

I got a series of X-rays. Waited some more. Got a CAT scan, which was very interesting–being shuttled back and forth into a huge steel maw while holding your breath at the command of a light-up smiley face is something I’ll not forget. Waited some more.

Finally, after almost ten hours of waiting, the doctor came in to examine me. He’d been in once before for about two seconds, poked and prodded me, then vanished to deal with his many other obligations. This time, he had good news–they couldn’t find any serious illnesses, no appendicitis or ruptured colon, so they were letting me go with some pain medication and instructions on what to do. I was both relieved and flabbergasted. Relieved that I wasn’t dying or seriously ill, and flabbergasted at how it took them ten hours to get to this point.

Then the fun came. I signed a bunch of forms at checkout, and when I asked for my bill, I was told it wasn’t ready yet. (What kind of industry can function where you can not be billed for services when you use them? How does that work?) I demanded an estimate and got one–on the order of $13,000 at least. I was horrified. I basically sat in rooms for hours, got X-Rayed and CAT-scanned, and that cost me $13,000? The woman at the desk showed me how expensive the scans were. I couldn’t believe it. Fifteen minutes of being shuttled back and forth on a slide cost me $5,000.And of course, the doctor himself isn’t actually an employee of the hospital, so I’d probably have to cough up another $300 to pay him, just for seeing me a total of ten minutes and poking and prodding me.

Noting my distress, the worker noted that I qualified for a number of cash discounts that halved my bill considerably, but that "it wasn’t the final bill" and more could be added. I would have to wait at least another two days to get that. I put a massive deposit down, wiping out my savings, and she gave me some numbers to call to talk to people about negotiating the bill down further. A dirty little secret of the industry is that doctors often overbill the insurer because the pooling system of risk makes it easier to do so, much like how lawyers and other consultant types pad their work time out to get paid more, so people like me can often settle bills for far less than normal. It’s not their fault, really–it’s how the system is designed.

That’s really the key here. I’m not mad at anyone who helped me at the hospital–far from it. Every doctor, nurse, specialist, technician, etc. was kind, courteous, helpful, and considerate. They just are parts of a system that overworks them to no end. Part of a system that offers perverse incentives for expensive, high-tech exams you may not need. Part of a system that encourages overspecialization at the expense of community and primary care physicians. Part of a system that places profit over people’s well-being. Part of a system that knows how much people value their health and fear death, and traffics in that fear for the sake of pleasing shareholders. Part of a system that demands incredibly high salaries not just for the hope of attracting people to the field, but to help shield them from liability and malpractice lawsuits, which can destroy careers (sometimes deservedly, sometimes not). Part of a system that can leave people completely bankrupt due to the insane costs of medical treatment, even if they’re fully insured.

Listen to the testimony of former CIGNA exec turned apostate Wendell Potter to Bill Moyers:

Well, there’s a measure of profitability that investors look to, and it’s called a medical loss ratio. And it’s unique to the health insurance industry. And by medical loss ratio, I mean that it’s a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry’s been dominated by, or become dominated by for-profit insurance companies. Back in the early ’90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they’ll punish them. Investors will start leaving in droves.

I’ve seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street’s expectations with this medical loss ratio.

For example, if one company’s medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that’s ridiculous. And it’s horrible.

As my sister said, it’s 200-fucking-9 in the United States of America. We should not be afraid of getting medical help. We should not cower in fear and anxiety over paying our bills when all we want to do is focus on our health and getting well. A single incident can change your life forever. Trust me, I know–a week ago this time I was over the moon and loving life. Now I’m anxious, fearful, still not feeling well, and stressed beyond imagining. Is this what it means to be healthy in our system?

People say that Medicare’s excessive bureaucracy makes it a bad model for health care to follow. To that I say, how is that any different from what we have now in the slightest? Do we not still fill out dozens of forms, endure long lines and rows of faceless bureaucrats who don’t even know our names? Do we not still end up used and abused by an impersonal, inhuman system that views us as losses against a profit margin? How is our current, corporatized, for-profit system really any more efficient or less bureaucratic than the dreaded "government health care?"

The thing that has always swayed me in favor of public health care is that it frees you (for the most part) from fear. You don’t worry about paying the bill. You don’t worry about it being there or not. It’s there when you need it, and it encourages you to get well, as opposed to waiting until you’re sick just to get insured. True, it has more than its share of problems, but I’ve seen the VA system and Medicare help my parents through a host of ailments for many years now. I don’t know what they would have done without it.

There is a lot of positive news on this front. Both the House and Senate have released their versions of health care reform bills, and both have passed out of their first committee introductions, marking a huge step towards getting them voted on. I’m not cognizant enough of the technical details to give a really cogent analysis, but the general opinion is that they don’t suck. If you don’t have time to read or review the full bills, Matt Yglesias and health care mega-expert Ezra Klein have good takes on them. As their commenters note, not everything is peachy keen about the bills by a long shot, but they strike me as a very big step forward from the failures we have now. I’m no fool–I know there are a million ways this can get screwed up before it hits Obama’s desk (if it does at all), but I just have an instinct that says this time, the little guy really will win.

And let’s not forget, we have a rather formidable ally in our corner when it comes to health care reform in general and a public health plan in particular. It literally is a battle for the ages. On one side, a colossal bureaucracy with billions to spend in lobbying recalcitrant and weak-willed Congressmen to avert or avoid real reform. On the other, not only is the personal muscle of the President of the United States, but the organizing and activism machine that transformed politics like never before. Most of all, alongside them is the will of the American people to push for real reform–and after decades of horror stories, broken promises, and spiraling costs, that will has never been stronger.

What about me? Well, physically I’m almost 100 percent again. Whatever it was that felled me cleared up over the last 48 hours and I’ve been getting back to the gym, eating solid foods, etc. I talked to other people in the area, and many of them said they got sick in the same time span with no explanation. Was it swine flu? Bad food? Viral outbreak? Aliens? Who knows? The many bizarre and inexplicable maladies that our overindustrialized, overmedicated, unhealthy world exposes us to is a whole post in and of itself.

Financially, I’m still waiting to formally negotiate my bill down by a large chunk, but I am told my odds are very good. Plus my employer has graciously agreed to cover another large chunk of it. Even beyond that, I’m still looking at $6K in medical debt. To that end, I’ve added a PayPal donation button at the bottom of this page. I’ll also be setting up a special donation page while my wonderful sister works on adding a widget to the site. Loath though I am to ask anyone for assistance, this time I really need it. If I’ve ever done a solid for you for anything over the years–financially, professionally, personally, emotionally, or in any way, shape or form–think about that, and help a brother out. Any money I don’t use will be returned to the donor or given to a health care reform or health-related organization of your choosing–on that I give my word.

In the meantime, I will not wait another moment to add my voice to the call for a real public option for health care that will give the 47 million without insurance and millions more with little coverage a chance to free themselves from that fear. Disease is scary. Accidents are frightening. Your health care shouldn’t be.

Here’s what I am doing–and what you can do as well:

Throwing my support behind a robust public plan for health care.

Telling my Congressman (Henry Waxman, in this case) to take the pledge for real health care reform and not settle for anything less than full public health care for all.

Supporting the Obama administration’s push for electronic medical records that are under your control, protected with strong privacy laws, and not usable against you by any employer or any insurer for any reason.

Ensuring that health care reform isn’t just about providing coverage to the uninsured, but reforming the system to prevent excessive overbilling, medical errors, and other costly mistakes and bureaucratic snafus that only harm the patient and waste the provider’s time.

I have faith that my current issue will turn out okay. I’ve been through worse, after all. I think, in a philosophical sense, that I am going through this at this exact time in order to drive home how serious the need for better health care is. Listen to my story, share it, repeat it, and do everything you can to support real health care reform for all.

Like I said, being sick is scary enough. We don’t need to be afraid of getting well.

mboz

mboz

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